B O O K REVIEWS J o h n M. P o r t e r , M D , B o o k R e v i e w Sec t ion E d i t o r

The maintenance o f arterial reconstruction R. M. Greenhalgh, L. H. Hollier, eds. Philadelphia, 1991, W. B. Saunders, 512 pages, $155.00.

In the preface the editors state that this book, the most recent in a series by Professor Greenhalgh and his associates, is concerned with the long-term durability of arterial reconstrdctions and an analysis of the factors that influence the long-term results. Unfortunately, they do not succeed in attaining this goal.

The book has 43 chapters, which are divided into seven sections, and common problems that cause late failure of arterial reconstructions are considered. Included are a discussion of intimal hyperplasia, the necessity for surveil- lance of arterial reconstructions, and long-term results of selected arterial reconstructions. The book emphasizes the problems of peripheral arterial reconstructions with some consideration of carotid endarterectomy and only passing reference to visceral reconstructions.

The inclusion of nine chapters devoted to endovascular techniques including angioplasty, laser assisted angio- plasty, atherectomy, and the placement of stents is puz- zling. Their relationship to the maintenance of arterial reconstruction is unclear. Unfornmately, these chapters describe the respective techniques in great detail, generally by a proponent of the approach, but provide no substantive information on indications for or efficacy of these proce- dures, as so few patients have been treated. Clearly the editors do not place in perspective the role of these procedures in treating peripheral vascular disease.

As with any book with many authors, the chapters are of uneven quality, with some providing minute detail of experimental techniques or case analyses and others being quite superficial. In addition, significant duplication of material exists, particularly in the chapters related to intimal hyperplasia and endothelial cells, the results of carotid endarterectomy, and the role of duplex surveillance of grafts in the postoperative period.

I am surprised that more attention is not devoted to intraoperative assessment, which is discussed in only a cursory fashion. It is clear that careful intraoperative assessment is critical in assuring the technical excellence of the surgical procedure and obviously has a profund impact on long-term results. One gets the impression from this book that all postoperative recurrences represent disease progression. In my opinion, the possibility ofnnrecognized persistent disease receives inappropriately little attention in this volume.

In spite of these shortcomings some chapters are very good. Drs. Kohler and Clowes' chapter entitled "The Regulation of Intimal Hyperplasia After Arterial Recon- struction" is excellent as is the chapter entitled "The Impact of Non-operative Therapy on the Management of Vascular Disease" by Dr. Veith. Data on the late results of operation

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versus percutaneous transluminal angioplasty for renal artery stenosis is well discussed by Dr. Bergentz. Drs. Veller, Fisher, and Nicolaides have contributed an excellent chapter on preoperative assessment and its influence on long-term results.

The price of the book at $155.00 is discouraging. Potential buyers may well find a more rewarding return for investment elsewhere.

Ralph B. Dilley, MD Scripps Clinic and Research

Cerebral monitor ing in the operating room and inten- sive care unit

Enno Freye, Dordrecht, 1990, Kluwer Academic Publishers, 196 pages, $85.00.

This monograph represents volume 22 in the series on Developments in Critical Care in 34edicine and Anesthesiology. It was written primarily for the anesthesiologist, intensive care therapist and other nonsurgical personnel in the operating room and/or the intensive care unit, and is intended as an introductory guide for one embarking upon the routine use of electroencephalographic (EEG) and evoked potential monitoring. The book appropriately stresses both the practical and technical aspects of daily cerebral monitoring. The author provides excellent cover- age of the potential and shortcomings of cerebral monitoring; practical information on data to interpret data in the presence of various physiologic variables and pharmacologic agents; the technique of proper electrode placement and its importance; and methods to detect electrode misplacement and extraneous electrical noise. The generous use of specific examples and illustrations empha- sizes these points. The overall book organization is satisfactory, and the hsting of the important points in a vertical column format makes the reading easy.

However, several weaknesses prevail. The author assumes that the reader considers cerebral monitoring a necessity and thus provides little discussion of when and under what circumstances monitoring should be imple- mented. The editing is suboptimal, with frequent awkward word choices and unclear figures that are difficult to interpret.

Sections 20.2 and 20.3, summary of the chnical application of evoked potential monitoring in the operat- ing room and in the intensive care unit, respectively, would appear better placed in the main text rather than the appendix. The instructions for electrode placement de- scribed in the main text would appear better positioned in the appendix with the section on care of the electrodes. The one-page discussion on electroencephalographic monitor- ing during carotid endarterectomy is particularly weak and